Enid Leikin

Failure To Detect Vertical Transmission of Hepatitis C Virus

Abstract ▪Objective:To search for transmission of hepatitis C virus (HCV) from infected mothers to their infants. ▪Design:Prospective clinical, serologic, and molecular biologic follow-up (at least...

Correlation of neonatal nucleated red blood cell counts in preterm infants with histologic chorioamnionitis

OBJECTIVE The aim of this study was to compare the neonatal nucleated red blood cell counts in preterm infants in the presence and absence of clinical and histologic chorioamnionitis while controlling for gestational age and birth weight percentile. STUDY DESIGN Nucleated red blood cell counts were obtained from preterm infants delivered after preterm labor or preterm premature rupture of membranes. Patients were divided on the basis of clinical and histologic chorioamnionitis. Nucleated red blood cell counts between groups were compared, and regression analysis controlling for gestational age and birth weight percentile was performed. RESULTS Of 359 patients, both measures of infection status were significantly associated with increased nucleated red blood cell counts. In the regression analysis histologic chorioamnionitis retained significance, whereas clinical chorioamnionitis did not. CONCLUSIONS Histologic chorioamnionitis produces an erythropoietic response in the fetus. Whether fetal erythropoiesis is a direct response to mediators of inflammation or whether it is the result of a rise in erythropoietin is unknown.

Relationship between neonatal nucleated red blood cell counts and hypoxic-ischemic injury

Objective To determine if nucleated red blood cell counts (RBC) are different in infants who develop intraventricular hemorrhage and periventricular leukomalacia in the first week of life and in those who do not. Methods Nucleated RBCs were obtained from 441 infants weighing more than 499 g and less than 1751 g. Neonatal cranial fontanel sonography was performed on days 3 and 7 of life, and neonates were divided into those with normal and abnormal sonographic findings. The nucleated RBCs were compared between these groups and between normal and abnormal groups matched for birth weight and gestational age. Results Mean gestational age, birth weight, birth weight percentile, Apgar score, respiratory distress syndrome and mortality were different between the infants with normal and abnormal ultrasound findings. The nucleated RBCs (per 100 white blood cells) were not different (40.5 ± 126.8 versus 41.8 ± 71.7, t = 0.09, P = .9). When we controlled for gestational age and birth weight, there was no significant difference between nucleated RBCs in those with normal and abnormal sonography (54.3 ± 206.5 versus 41.4 ± 72.0, t = 0.56, P = .6). In growth-restricted neonates, there was a significant increase in nucleated RBCs regardless of whether growth restriction was defined as tenth percentile or less, 25th percentile or less, or 50th percentile or less, even when we controlled for gestational age. Conclusion Nucleated RBCs are not different in preterm infants with or without intraventricular hemorrhage and periventricular leukomalacia, even when one controls for gestational age and birth weight. There are significant elevations in nucleated RBCs in growth-restricted fetuses. Birth weight percentile must be considered when using nucleated RBCs as a marker of intrauterine hypoxia.

VIRAL HEPATITIS IN PREGNANCY

Acute and chronic necro-inflammatory liver disease caused by hepatotropic virus infection continues to be a major worldwide health problem. Approximately 5% of the worlds population has chronic hepatitis B virus (HBV) 82 as many as 100% of the residents of nonindustrial nations and 70% of the residents of industrial nations have serologic evidence of prior exposure to hepatitis A virus (HAV), 54,70 and in the United States, end-stage liver disease caused by chronic hepatitis C virus (HCV) is the most common indication for orthotopic liver transplantation (OLT). 23,54 Acute and chronic viral hepatitis often affects women of child-bearing age and their infants. In regions of the world where chronic HBV is prevalent, most new cases are the result of perinatal or neonatal infection. HAV infection usually occurs during childhood or in young adults, including those in their early reproductive years. 25,70 HCV infection often is acquired by teenagers and young adults as a result of drug use and also is common in persons with a history of sexual promiscuity. 10,19 Thus, individuals providing health care to young women are likely to encounter patients with viral hepatitis and must be prepared to deal with issues related to acute and chronic infection, sexual and vertical transmission, and screening and treatment.

Seronegativity to varicella-zoster virus in a tertiary care obstetric population

Objective To determine the seronegativity rate of varicella-zoster virus in a tertiary care obstetric population. Methods At their initial prenatal visit, all obstetric patients at Westchester County Medical Center have a varicella-zoster virus IgG antibody titer (Varicella Stat; Biowhit-taker, Inc., Walkersville, MD) performed. A value of 0.99 or greater units is positive. Patients were divided into three groups: seronegative, seropositive, and those with no test results. Mean maternal age was compared among groups using the unpaired two-tailed Student t test, with P < .05 considered significant. Results From February 1, 1994, to May 30, 1996, 927 women had an initial prenatal visit. Ninety-nine patients were varicella-zoster virus antibody negative (seronegativity 11.6%, which is significantly higher than that reported in other studies); 755 were varicella-zoster virus antibody positive, and 73 had no results. The mean age of the seronegative patients was 27 years and of the seropositive patients 28 years, which was not significantly different. Conclusion Varicella-zoster virus seronegativity is higher in our obstetric population than generally is reported in adults. This may reflect the number of immigrants from tropical countries attending metropolitan hospitals. Mathematic models evaluating the impact of varicella-zoster virus vaccination and decisions regarding screening and postpartum vaccination must be based on accurate epidemiologic data, particularly in view of the effect of varicella-zoster virus on pregnant women, their fetuses, and their neonates.